Our project partners Egerton University, Kenya convened a workshop Agro-biodiversity and Dietary diversity for optimal nutrition and health on Tuesday 22nd August, 2017 at the ARC Hotel Egerton University, Kenya. Forty-Five participants from academia, Ministry of Health, Ministry of Agriculture and NGOs working on Agriculture, nutrition and health gathered together with representative from County Government to discuss the important issue of tackling malnutrition and links between agriculture and Nutrition. See workshop report.

The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in East Africa’ on Thursday 8 June 2017, at the Southern Sun hotel, Nairobi, Kenya. A hundred participants from NGOs and academia working on nutrition, health, child welfare and development gathered together with government ministers from Kenya and Ethiopia, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in East Africa.

Grainne Moloney, Head of Nutrition in Kenya for UNICEF and member of the Transform Nutrition Consortium Advisory Group gave her reflections on the day at the end of our meeting in Nairobi on 8 June 2017.

“Thanks to all for coming today and for your excellent participation. I do feel we are all very privileged to have been able to be here today and have access to such important and cutting edge research that we can immediately take back and apply to our work. Most of the time we are all too busy to reflect on the new papers/ evidence being published so today we had the opportunity to come together in our different communities from Government, academia, research, policy makers, programmers all with a common goal of how to improve the nutritional situation of children in Africa. We had time to openly discuss the latest findings and opportunities of application – this is rare. We also must acknowledge that most regions in the world are now seeing reductions in the absolute numbers of stunted children, with the exception of West Central East and Southern Africa so the learning from today is vital to help us all to get the numbers and indicators moving downwards by applying this learning immediately in our day to day work. The fact that you are all still here after 5pm on a weekday given we are now deep in traffic in Nairobi, also shows your interest in today’s meeting and on behalf of you all I would like to specifically thank the Transform team and the local organizing team of Save the Children for arranging and inviting us all to such an interesting and successful day.

o Session one ~ Stories of Change in Nutrition: Africa set the basis of what works in terms of success stories in stunting reduction based on a review of several case studies- we learned the key common drivers and factors that need to be in place to reduce undernutrition and the case studies illustrated a common theme over and over again. While as a community we have struggled to find the silver bullet to reduce stunting from the quantitative side – now we know the important factors that do have an impact and that it doesn’t have to take generations, that changes in the short term are possible with the right enabling environment – this is something all of us today can carry back to our countries – where we can all write our own story of change and review where we are and what areas we need to focus on more.

o Session two ~ Nutrition sensitive social protection brought the latest evidence on the very topical areas of social protection and nutrition – with 2 solid country examples from Ethiopia and Kenya as well as the review of other studies by John Hoddinott on the potential for its role in stunting reduction. We know the research from Latin America has shown good results – but we have yet to see these same results in Africa – why is that – what are the issues and learning around targeting, monitoring, transfer value and what do we need to consider when we design such programmes. The experience from Ethiopia and Kenya clearly highlighted the evolution of the large Government led programmes for the most vulnerable populations and that over time they are becoming much more nutrition sensitive. It is important to recognize these are dynamic programmes whereby we, as the nutrition community, now need to be more proactive and be at the table to advocate for increased nutrition sensitivity in the design. And let’s generate that evidence for Africa as this is a gap and let’s look at the wider welfare programmes also as an opportunity to influence — and not just cash transfers as ultimately this is the future for support to our vulnerable communities.

o Session three ~ Transform Nutrition research from Kenya and Ethiopia then highlighted several innovative research studies supported by Transform Nutrition that aim to improve nutrition outcomes. The studies ranged from technological innovation in terms of using handheld devices in nutrition programmes which looked not just at the time saving side but also on efficiency and quality assurance to new approaches in using Social Returns on Investment (SROI) and giving a new importance and value to people’s perceptions of caring for their children. Finally we heard 2 case studies that reinforced some of the earlier learning on social protection, that if we don’t make that connection to the household and the behaviors and needs of that household in the design of our programme and only focus on the supply side such as increased production, we will not have an impact on improving nutrition outcomes.

o Session four ~ Leadership in nutrition was a highly inspiring and motivating session where we had the privilege to learn from Transform’s nutrition champions who through their commitment energy and belief in their work- have made extraordinary influence and gains in their sector. Again common themes emerged through each of the stories- and we can all take something from them. The role of leader also was highlighted but not always in the traditional sense of a senior Government official but in all the work we do – we can all be champions to improve the agenda , also the stories highlighted it is not always easy , there are often conflicts of interest that we have to manoeuver but some of the key learning was the importance of getting people together, having a common vision, dealing with the challenges and being self aware of what is possible- so let’s all take inspiration from these great women and do our bit to get nutrition on the agenda in our countries.”

A mobile health application developed to help with Integrated Management of Acute Malnutrition (IMAM) which enables health workers and volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill,was evaluated in 40 health facilities in Wajir Kenya. A research brief is now available Preliminary findings from a malnutrition mobile app randomised trial in Wajir, Kenya which summarises the findings.

Community based Management of Acute Malnutrition (CMAM) is a proven high-impact and cost-effective approach in the treatment of acute malnutrition in developing countries. However, success is limited if treatment protocols are not followed, record keeping and data management is poor and reliable data is not available in time for decision makers.

A new Transform Nutrition research brief A mobile app to manage acute malnutrition is now available. In this brief programme staff in Niger, Chad, Mali, Kenya and Afghanistan discuss the challenges they faced adapting a mobile health app and rolling it out in some of the most remote, hard to reach health facilities in the world and make valuable recommendations for other mobile health application developments .

From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition. On 8 June Transform Nutrition is hosting a regional meeting Using evidence to inspire action in East Africa in Nairobi, Kenya.

This regional meeting will present experiential learning from other African and South Asian countries on key drivers to improve nutrition status, along with evidence on work works in nutrition-sensitive interventions, to policymakers from Kenya and international donors and NGOs in the East Africa region. It aims to inform and equip them to address the particular challenges of tackling child undernutrition in their current contexts. See agenda and press release.

While the prevalence rates for wasting and underweight have declined over the past three decades, the stunting rate has increased to over a third (35%).

Undernutrition situation in Kenya

In Kenya, almost a third of the population (10 million people) are chronically food insecure. The country’s food and nutrition insecurity is often attributed to the performance of the agricultural sector. However, recent growth in the sector has not led to full food security for the country. In fact, in the last 30 years, per capita food availability has declined by more than 10%.
Acute and chronic undernutrition and micronutrient deficiencies primarily affect pregnant and lactating women and children under five years of age. Although the Kenya under five mortality rate declined significantly between 2003 and 2009, it has increased in recent years. Undernutrition remains a significant contributing factor to child mortality. 7% of children under five are wasted and 16% are underweight. The prevalence rates for wasting and underweight have declined over the past three decades. However, the stunting rate has increased to over a third (35%) representing 2.1 million children.
Almost half (46%) of children aged between 18 and 23 months are stunted while children under six months are 11%. Mothers with a low body- mass-index tend to have children with higher stunting levels, while mothers with longer birth intervals reduce the likelihood of their children being stunted. The UNICEF table shows the trends of undernutrition in Kenya from 1993 to 2008 according to the Kenya Demographic and Health Survey.

Policy

Vision 2030, the long-term development blueprint, aims to transform Kenya into a globally competitive and prosperous nation with a high quality of life by 2030. Achievement assumes a healthy and productive human capital, nurtured by good nourishment from infancy into adulthood, in tandem with proper disease control, good hygiene and sanitation, and caring practices.
The estimated cost of stunting to Kenya’s economy in 2010 was over US$1 billion. Over 20 years it would result in the deaths of 700,000 people. Unless addressed undernutrition poses the biggest threat to Vision 2030. More imminently it poses a threat to meeting the Millennium Development Goal 1 on child survival.
Recent investments into agriculture, water and sanitation, social protection and health systems have not had an impact on the nutrition status. These programmes have not been sufficiently targeted to improving the nutrition status.
At national level, policies do not reflect the multi-faceted causes of malnutrition. Nutrition is barely referenced in most food security and related development policies and programmes. In the government’s Vision 2030, nutrition is conspicuously absent. Even the current health ministry strategy, relegates malnutrition to a sub-target under the twelfth priority of the second strategic thrust health. Kenya is also a signatory to several international conventions on hunger and malnutrition but this is has not been translated into tangible results.

Opportunities for influence

However, recent developments are encouraging. The new Kenya Constitution recognises the right quality and quantity of food as a basic right for children. Policies need to be aligned to this so that ministries of agriculture, education and irrigation and water are more nutrition sensitive.
The National Nutrition Action Plan is currently being finalised. It defines cost-effective and high impact activities, and includes a strategic focus on increasing the demand and use of research to influence policy and practice. Its success is hinged on a wholesale allocation of financial, human and operational resources.
Read the Kenya Situation Analysis (PDF) prepared for Transform Nutrition.

Stakeholder mapping

The Kenya stakeholder workshop took place in Nairobi, November 2012 and included participants from the Kenya Government, national NGOs and civil society organizations, international NGOs and bilateral and international donors and agencies. Organised by Save the Children, Kenya and the University of Nairobi, partners plotted the principal actors in the nutrition policy environment, drawing links to show their perceptions of the main funding and advice links. See the Stakeholder Mapping Report Kenya (PDF).

Partners

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Transform Nutrition is a consortium of five international research and development partners funded by the UK Department for International Development. Using research-based evidence we aim to inspire effective action to address undernutrition.